Additional Resources

ASPS Advocates for E&M Changes

Wednesday, February 19, 2020

In their 2019 final rule, CMS indicated it will be changing the coding and documentation structure for Evaluation and Management (E&M) services. Together with the AMA, ASPS worked to further refine the CMS proposal and updated the coding guidelines for both New and Established patient visits. This last month, Dr. Dan Ness, ASPS's CPT Advisor, attended an AMA briefing along with ASPS staff, and reported the following:

For CY 2021, E&M documentation and billing changes include:

Eliminating history and physical as element for code selection.

Allowing physicians to choose whether their documentation is based on medical decision making (MDM) or total time.

Deletion of CPT code 99201 (new patient level 1 E&M service).

While E&M services are not the majority of the work ASPS members provide, these updates will have implications on how services can be documented and could restrict the choice of codes assigned. Additionally, EHR software should be reviewed immediately to ensure new templates are available by January 1, 2021.

Of note, these changes impact new and established visits only. The billing guidelines for hospital observation, hospital inpatient, consultations, Emergency Department, nursing facility, domiciliary, rest home, custodial care and home E&M services will not change.

ASPS will continue to provide updates for these and other CPT code changes in CY 2021. In the short term, questions regarding billing and coding may be sent to ASPS staff via email at eadler@plasticsurgery.org.